Written by Dr. Szto

Atrial fibrillation (AF) is the most common heart rhythm disturbance in the world. Normally the heart chambers pump in a regular and rhythmic manner. The top two chambers (atria) will pump first, squeezing the blood through the valves to the bottom chambers (ventricles). In atrial fibrillation, the top chambers (atria) are beating erratically, like a wriggling “bag of worms”. As a result, the normal electrical conduction does not occur down to the ventricles, creating an irregular pulse. The atria do not empty blood properly, resulting in a higher likelihood of small clots forming along the walls of the chambers. In particular, the left atrial appendage, a long thin redundant appendage in the left atrium, often is the culprit containing the clot. If the clot breaks off from here, and travels around the body, it can occlude the normal circulation. When this clot blocks circulation to part of the brain, it results in a stroke.

Atrial fibrillation is the major cause of stroke in the population, particularly the elderly. This is mainly because atrial fibrillation is also the main heart rhythm disturbance in the elderly. Half of all patients admitted to hospitals with a stroke are due to atrial fibrillation. Clearly preventing stroke when a patient has atrial fibrillation is a very important public and personal health issue.

There are factors in an individual that increase the likelihood of stroke if he/she has atrial fibrillation, namely: age over 75 years (over 65 for females), high blood pressure, diabetes, heart muscle enlargement, and a history of stroke or warning stroke (transient ischaemic attack or TIA).

Taking aspirin can reduce the stroke risk in patients with AF. Taking warfarin is even better in reducing the risk of stroke. It is estimated that warfarin can reduce the risk of stroke by two-thirds. However, taking warfarin can have its problems too. Keeping warfarin at a therapeutic range is sometimes very difficult, as the dose varies in individuals. Frequent blood tests are required. Sometimes, the blood can become so thin patients may bleed. These include nosebleeds, bleeding from the bowel, or bladder or from the lungs. Sometimes the bleeding can be catastrophic.

There is an alternative taking blood thinners to prevent a stroke in patients with atrial fibrillation. This involves closing the left atrial appendage with a device. This device (Watchman) is shaped like a parachute or umbrella. By closing the left atrial appendage, most of the risk of clots forming is abolished (it is thought that up to 90% of all clots causing a stroke originate from the left atrial appendage).

This key-hole procedure is done under a general anaesthetic, and takes approximately one to two hours. The procedure involves insertion of a catheter from the groin vein to the right side of the heart, making a small puncture in the septum between the right and left top chambers, and inserting the Watchman device carefully into the mouth of the left atrial appendage. The patient then stays overnight in Peninsula Private Hospital CCU and will be discharged the next day after satisfactory progress.

A repeat trans-oesophageal echocardiogram is performed 6 weeks after the procedure to ensure that the device is fully sealed, after which the patient can stop taking warfarin and continue to take aspirin only. Dr. Szto has commenced performance of this procedure at Peninsula Private Hospital in the last 6 months.

WATCHMAN LEFT ATRIAL APPENDAGE CLOSURE DEVICE

MAY 2014 VOLUME 1 – ISSUE 1

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Cancer…the word itself sends shivers down the spine. However, unlike many other forms of cancer the survival rate for men with prostate cancer is quite high. The 5 year survival rate for diagnosed men in Australia is 93%, 10 year survival is 92% and the 15 year survival rate is 77%.

The prostate is a small gland about the size of a walnut located between a man’s penis and bladder. It surrounds the urethra which is the tube that carries urine from the bladder to the penis. The prostate’s main function is to help produce semen.

Prostate cancer is the most common cancer in men and the chances of developing this type of cancer increase with age. The symptoms don’t usually appear until the cancer has grown large enough to put pressure on the urethra and can include:

• needing to urinate more frequently, often during the night

• needing to rush to the toilet

• difficulty in starting to urinate (hesitancy)

• straining or taking a long time while urinating

• a weak flow while urinating

• feeling that your bladder is not completely empty once you have urinated.

These symptoms should be investigated by your doctor, but they don’t mean you have prostate cancer. Many men’s prostates get larger as they get older due to a non-cancerous condition known as ‘benign prostatic hyperplasia’ or prostate enlargement.

Treatment and its Side Effects

Common treatment methods for prostate cancer, like Androgen Suppression Therapy (AST) or Androgen Deprivation Therapy (ADT) do have some nasty side effects. Prostate cancer survivors are at increased risk of osteoporosis, loss of muscle mass (sarcopenia), weight gain, impotence, fatigue, depression and developing type 2 diabetes. They also can become incontinent. Studies have now shown that the leading cause of death amongst prostate cancer survivors is in fact cardiovascular disease.

The question now becomes, what can you do to not only survive the cancer but to ensure the highest quality of life post treatment?

Exercise Enhances Quality of Life

It’s all pretty deflating on top of having prostate cancer. However, research paper after research paper has come out and talked about a key treatment for these side effects; you guessed it….. EXERCISE!

Galvao, in a 2010 medical journal article put it nicely in saying: “Physical exercise has been suggested as a key intervention for clients that undergo this treatment due to its potential to limit and even reverse these toxicities”. Other treatments such as radical prostatectomy, cryotherapy, brachytherapy and high intensity focused ultrasound can all lead to urinary incontinence and depression. This too can be managed with exercise such as pelvic floor exercises before and after treatment.

EXERCISE STRIKES DOWN PROSTATE CANCER’S EVIL SIDE-KICKSACTIVE ONE NEWS…

ADDITIONAL INFORMATION

A healthy diet and lifestyle may help lower the risk for prostate cancer; the same is true for those men diagnosed with prostate cancer in terms of cancer recurrence. Researchers suggest a diet low in fruits and vegetables but high in meats and high-fat dairy products increases the risk for prostate cancer.

The mechanism(s) for this is being investigated but current speculation suggests meat and high-fat foods contain compounds that augment the growth of cancer cells.

Put simply…

1. Increase frequency and portion sizes of fruits and vegetables

2. Eat whole grains and avoid processed grains, white flour and refined sugars

3. Reduce or stop eating high-fat dairy products and meats, especially processed meats like ham, sausage, salami and bacon

4. Limit or eliminate alcohol

It is with pleasure that we officially introduce Wendy Cowan to the Active One team. Wendy has studied fashion design and remedial massage. She has lived and worked in Japan for a year teaching English and worked closely with allied health practitioners in treating patients with injuries, aches and pains. To fit in with life as a mother of 2 young children, she has taken on a part time administrative position with Active One and has enthusiastically joined our Saturday 9.30 class, at times dragging the whole family along with her!

We would like to congratulate Nakita and Josh who were married last year. The reception was held at Trent and Georgia’s house with a number of Niki and Josh’s friends and family in attendance. A live Skype call was made to Niki’s parents in South Africa and speeches made by a number of their friends. We all had a fantastic day/night and wish them a long and happy life together.

Niki and Josh after getting married

“In other great news, on Saturday 5th of April, Dario and his wife Bilijana - had their second child, a girl named Lana. Everything went well

with Lana weighing in at 3.3kg and 50cm in length; happy days for the Vidackovic family!”

Dario and new baby girl Lana

Recently we had two clients achieve great success in their debuts in the Melbourne Marathon. Congratulations to George Malcolm (Trent’s father) and Ben Ferguson.

George at the 16km mark waving to his fans (2 granddaughters!)

At the age of 65, and off limited preparation, George chugged along like an old steam train for his first half-marathon (21.1km); it took him 2 hours and 5 minutes. There’s some inspiration for some of our older clients to get out and have a go at these things!

And Ben Ferguson, golf professional at Peninsula Country Golf Club, ran his first marathon in a very respectable 3 hours and 53 minutes. Ben has shed 15kg since starting with us 12 months ago.

In one of our recent healthy lifestyle workshops (the Life! program) in Frankston, Les Tunes achieved some great success losing 10kg and 14cm from around his waist. He feels more energetic and is finding day to day

activities much easier now, not to mention significantly reducing his risk of diabetes, heart attack and stroke. Making changes is challenging at any age, however at 77, Les is a great example and inspiration to our older clients – clearly it is never too late to change and improve your quality of life!

Les Tunes gives the Life! program the thumbs up

Active One has recently started consulting in Berwick. We are consulting 1:1, running group exercise classes and facilitating our FREE healthy lifestyle workshops (the Life! Program). We are planning on growing this area in 2014 and any help to get the “word out” would be greatly appreciated!

Finally, after 18 years together, Trent Malcolm and Georgia McIntyre got married. The wedding was held in Queenstown, New Zealand on the 29th December with their 2 young children, Grace and Madison, playing starring roles as flower girls.

Coronet Peak, Queenstown, NZ

Nakita Piroddi

CLIENT STORY: LOU PAPILE

Born in 1954 in Melbourne, Lou now lives in Carnegie with his wife, Maria and their 2 teenage daughters, Isabella and Angelica.

Medical Background: There were a number of conditions that Lou’s doctor (Dr. Alan Molloy at Eastbound Medical Centre - Bentleigh) was concerned about and all of them could be treated with lifestyle change. These conditions included elevated cholesterol, pre-diabetes and high blood pressure. He was also carrying too much weight and coupled with a strong family history of cardiovascular disease (with his father requiring triple bypass in his early 60’s) Lou’s risk of serious health problems were growing.

Client Involvement with Active One: In 2011, Dr. Molloy suggested he participate in the LIFE! Program, a program funded by the government to prevent diabetes, heart attack and stroke. It is here that Lou met Dario who was presenting one of the sessions.

Once the program finished, Lou joined our group exercise classes in Hampton and started to regain some respectable level of fitness, strength and mobility. He now trains with us 3 days per week.

Client’s Comment: I got a lot of great information from the Life! Program, but a large part of it was the motivation. I knew I had to do this stuff for my health but I just kept putting it off. I have always been too busy with family and work, whereas now, I just commit to a time and I make it work; I have to or I could end up “falling off the perch” a little sooner than I would like!

I was struggling with my back due to wear and tear prior to starting with Active One, in fact for a while there I couldn’t even walk straight let alone lift anything or run. I was seeing a physio regularly for a year but it wasn’t improving fast enough. My doctor even referred me to a neurosurgeon I was struggling that much.

However, I found that once I started with Active One (30 months ago) and gradually built up my strength and fitness, it made a massive difference. I now jog and lift quite heavy things with minimal restrictions under the supervision of the exercise physiologists. My pain is minimal and I see an osteopath for quarterly maintenance only; she says my back is more like that of a 30 year old!

I have lost 12 kg and sometimes can’t believe how fast I recover, and my strength and flexibility are now better than I can ever remember. I enjoy the work outs, the company of the regulars and the variety of exercise they give us. What you get out of it is what you put in and my results have come by training at a higher intensity. I feel great and the compliments from family, friends and work colleagues have been flattering.

For the last 30 months Active One has been part of my NEW LIFE and I am so grateful for their caring and encouraging approach. Here’s a big thank you to all the staff at Active One; I have now found the elixir of life!

BAKED APPLES WITH BERRIES

INGREDIENTS

• 2 cups (300g) frozen mixed berries

• 4 large apples (800g)

• 4 cardamom pods

• 1 cup (140g) yoghurt

• 2 teaspoons honey

METHOD

1. Place berries in fine sieve set over small bowl, cover; thaw in refrigerator overnight.

2. Preheat oven to 160°C/325°F.

3. Core unpeeled apples about three-quarters of the way down from stem end, making hole 4cm (1∏ inches) in diameter. Use small sharp knife to score around circumference of each apple. Make small deep cut in base of each apple; insert one cardamom pod into each cut.

4. Pack three-quarters of the berries firmly into apples; place apples in small baking dish. Bake, uncovered, about 45 minutes or until apples are just tender.

5. Meanwhile, mash remaining berries with a fork in small bowl; stir in yogurt and honey.

6. Serve apples with yoghurt mixture.

ACTIVEONE | PO Box 5134 Frankston South 3199 | Office: (+613) 8707 0830 | Mobile: 0409 384 522 | Fax: (+613) 8707 0778www.activeonegroup.com | www.activeonegolf.com.au | Email: info@activeonegroup.com

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